Advances in medical technology implemented in Neonatal Intensive Care Units (NICUs) have improved the survival rates of infants born in poor health. Yet there is mounting concern that relative to healthy full-term infants, NICU graduates may not develop educational and social skills fundamental to adapting well in our industrialized society. Our long-term goal is to understand the development of NICU graduates so that better provision can be made for their health and welfare. Our objective for this application is to ascertain whether there are delays in educational attainment and social adjustment of early adolescent NICU survivors in a cohort of children from the Lower Rio Grande Valley region of south Texas. Our central hypothesis is that perceptual-motor and nonverbal reasoning skills will be related to health antecedents, while development of verbal skills will be related to environmental antecedents. Our specific aims are to determine antecedent conditions associated with the development of educational, language and social skills, and with personality coping dispositions. We plan a comprehensive assessment of literacy and language skills, and plan innovative procedures to study language. We plan a culture-sensitive approach to norm-referenced testing designed to yield valid assessments of ability. Our strategy will be to conduct follow-up evaluations with a cohort of NICU graduates and a control group of healthy full-term infants born in the early 1990s. We conducted extensive developmental evaluations with this cohort of children when they were 12- and 22- months of age. Our cohort is predominantly indigent (57%), rural-dwelling and Hispanic. Forty-five percent of the families spoke only Spanish and 24% were English/Spanish bilingual. Sixty percent of mothers were first or second generation from Mexico. The proposed research is significant because little is known of long-term outcome of NICU graduates with a cohort such as ours, yet Hispanic populations are becoming an increasingly large sector of the United States population. The knowledge obtained should help us provide appropriate health and developmental screenings and plan intervention to lower disability rates, increase literacy and improve ability to function independently in our society.